Juvenile Idiopathic Arthritis Disease Activity Low but Stable During Pregnancy

Disease activity in women with juvenile idiopathic arthritis (JIA) was slightly but significantly increased 6 weeks postpartum, underscoring the need for close follow-up of this population in the first weeks after delivery, according to the results of a recent prospective, multicenter study published in the Journal of Rheumatology.

Investigators examined 135 pregnancies in 114 women with JIA. The median age of the study population was 29 years (range, 18-38 years); median disease duration was 20 years (mean, 4-36 years). Disease activity was evaluated at 7 different points before, during, and after pregnancy, using the Disease Activity Score-28-C-reactive protein 3 (DAS28-CRP3). Self-reported pain, physical function, and mental health were all rated by the patient.

Nearly 80% of the women were either in remission or had low disease activity during and after their pregnancies. DAS28 at 6 weeks postpartum increased significantly compared with during the first trimester (2.78 vs 2.51, respectively; P =.005) and the third trimester (2.78 vs 2.56, respectively; P =.011). 

Moreover, DAS28 decreased significantly between 6 weeks and 12 months postpartum (2.78 vs 2.54, respectively; P =.014). 

Based on the Medical Outcomes Study Short Form-36 Mental Health subscale, self-reported mental health was significantly improved at 6 weeks postpartum compared with before pregnancy (80.7 vs 76.5; P =.039). Patients’ self-reported pain remained stable. 

According to the Modified Health Assessment Questionnaire, physical function of the women was significantly worse in the third trimester of pregnancy than postpartum (0.57 vs 0.39; P <.001).

The investigators concluded that in pregnant women with JIA, disease activity was highest 6 weeks postpartum and was stable in the period from planning to become pregnant to 1 year after delivery. Additional research on pregnancy in subgroups of patients with JIA is warranted.

Reference

Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Disease activity of juvenile idiopathic arthritis during and after pregnancy: a prospective multicenter study [published online December 1, 2017]. J Rheumatol. doi: 10.3899/jrheum.161410